{"id":98,"date":"2019-09-22T17:51:38","date_gmt":"2019-09-22T21:51:38","guid":{"rendered":"https:\/\/opentextbc.ca\/nursingpharmacology\/chapter\/3-7-carbapenems\/"},"modified":"2022-12-12T15:14:26","modified_gmt":"2022-12-12T20:14:26","slug":"3-7-carbapenems","status":"publish","type":"chapter","link":"https:\/\/opentextbc.ca\/nursingpharmacology\/chapter\/3-7-carbapenems\/","title":{"raw":"3.8 Carbapenems","rendered":"3.8 Carbapenems"},"content":{"raw":"Carbapenems are a beta-lactam \u201ccousin\u201d to penicillins and cephalosporins.\r\n\r\n<strong>Indications for Use:<\/strong> Carbapenems are useful for treating life-threatening, multidrug-resistant infections due to their broad spectrum of activity.[footnote]Papp-Wallace, K. M., Endimiani, A., Taracila, M. A., &amp; Bonomo, R. A. (2011). Carbapenems: past, present, and future. <em>Antimicrobial agents and chemotherapy, 55<\/em>(11), 4943\u20134960. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3195018\/\"  rel=\"noopener noreferrer\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3195018\/<\/a>[\/footnote] These antibiotics are effective in treating gram-positive and gram-negative infections. Because of their broad spectrum of activity, these medications can be especially useful for treating complex hospital-acquired infections or for clients who are immunocompromised.\r\n\r\n<strong>Mechanism of Action:<\/strong> Carbapenems are typically bactericidal and work by inhibiting the synthesis of the bacterial cell wall.\r\n\r\n<strong>Nursing Considerations Across the Lifespan:\u00a0<\/strong> Some carbapenems (eg. meropenem) are considered safe for use in pediatrics. Dose adjustments are required based on renal dysfunction in older adults. Information related to carbapenems in pregnancy is limited.\r\n\r\n<strong>Specific Administration Considerations:<\/strong> Carbapenems are similar to cephalosporins.\u00a0 Cross sensitivity may occur in clients allergic to pencillin or cephalosporins.\r\n\r\n<strong>Client Teaching &amp; Education:\u00a0 <\/strong>Clients should monitor for signs of superinfection and report any occurrence to the provider.\u00a0 If a client experiences fever and bloody diarrhoea, they should contact the provider immediately.\u00a0 The client should also be advised that side effects can occur even weeks after the medication is discontinued.[footnote]uCentral from Unbound Medicine. <a href=\"https:\/\/www.unboundmedicine.com\/ucentral\"  rel=\"noopener noreferrer\">https:\/\/www.unboundmedicine.com\/ucentral<\/a>[\/footnote]\r\n<h1>Carbapenems Medication Card<\/h1>\r\nNow let's take a closer look at the medication card for Carbapenems.[footnote]Daily Med, <a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/index.cfm\"  rel=\"noopener noreferrer\">https:\/\/dailymed.nlm.nih.gov\/dailymed\/index.cfm<\/a>, used for hyperlinked medications in this module. Retrieved June 27, 2019.[\/footnote][footnote]UpToDate (2021). <em>Meropenem<\/em>. <a href=\"https:\/\/www.uptodate.com\/contents\/search\">https:\/\/www.uptodate.com\/contents\/search<\/a>[\/footnote] Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication.\r\n<div class=\"textbox textbox--learning-objectives\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\">Medication Card 3.8.1: Carbapenems (Antimicrobials)<\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n\r\n<strong>Class: <\/strong>Carbapenems\r\n\r\n<strong>Prototypes: <\/strong><a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=f41d8abd-7792-4918-1b93-bd83ea01955e\"  rel=\"noopener\">imipenem<\/a> and <a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=186e8e7c-0a2a-4e48-b5f7-a036f351ca5f\">meropenem<\/a>\r\n\r\n<strong>Mechanism: <\/strong>Bactericidal. Broad-spectrum for both gram-positive and gram-negative infections.\r\n<h3>Therapeutic Effects<\/h3>\r\n<ul>\r\n \t<li>Monitor for systemic signs of infection:\r\n<ul>\r\n \t<li>WBC<\/li>\r\n \t<li>Temperature<\/li>\r\n \t<li>Culture results<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li>Monitor site of infection for improvement<\/li>\r\n<\/ul>\r\n<h3>Administration<\/h3>\r\n<ul>\r\n \t<li>Onset: immediate (IV)<\/li>\r\n \t<li>Peak: 5 min<\/li>\r\n \t<li>Duration: 10-12 mins<\/li>\r\n \t<li>\u00bd life: 1 hr<\/li>\r\n \t<li>Geri: use cautiously<\/li>\r\n<\/ul>\r\n<h3>Indications<\/h3>\r\n<ul>\r\n \t<li>Complex body cavity, connective tissue infections in hospitalized pts.<\/li>\r\n \t<li>Bone, joint, skin, soft tissues infections<\/li>\r\n \t<li>Bacterial endocarditis<\/li>\r\n \t<li>Intra-abdominal infection<\/li>\r\n \t<li>Pneumonia<\/li>\r\n \t<li>Gynecological infection, UTI<\/li>\r\n \t<li>Septicemia<\/li>\r\n \t<li>Meropenem: only drug for bacterial meningitis<\/li>\r\n<\/ul>\r\n<h3>Contraindications<\/h3>\r\n<ul>\r\n \t<li><strong>Caution Drugs<\/strong>: Valporic Acid, Cyclosporine, ganciclovir, probenecid (not with Meropenem): worsen seizures, confusion<\/li>\r\n \t<li>pt\u2019s who have had <strong>anaphylactic<\/strong> rxns to beta-lactams<\/li>\r\n \t<li>Impaired renal function<\/li>\r\n \t<li>Pregnancy (only use if benefits outweigh risk to fetus)<\/li>\r\n \t<li>Hx of renal disease<\/li>\r\n \t<li>Seizure disorder<\/li>\r\n<\/ul>\r\n<h3>Side Effects<\/h3>\r\n<ul>\r\n \t<li>Similar to cephalosporins<\/li>\r\n \t<li>CNS: confusion, seizures, Neurotoxicity at high concentrations<\/li>\r\n \t<li>Resp: Apnea<\/li>\r\n \t<li>GI: GI upset (including dysbiosis, C-diff), <strong>N\/V, diarrhea, dehydration, <\/strong>electrolyte imbalance<\/li>\r\n \t<li>Derm: Rash (Drug reaction w\/ Eosinophilia and Systemic Systems<\/li>\r\n \t<li>Superinfection<\/li>\r\n<\/ul>\r\n<h3>Nursing Considerations<\/h3>\r\n<ul>\r\n \t<li>Monitor skin<\/li>\r\n \t<li>Monitor bowels<\/li>\r\n \t<li>Monitor labs<\/li>\r\n \t<li>Monitor CNS<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n<div class=\"textbox textbox--key-takeaways\"><header class=\"textbox__header\">\r\n<p class=\"textbox__title\">Clinical Reasoning and Decision-Making Activity 3.7a<\/p>\r\n\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n\r\n<span style=\"text-align: initial; font-size: 1em;\"><strong>Using the above information, consider the following clinical scenario question:<\/strong><\/span>\r\n\r\n<span style=\"text-align: initial; font-size: 1em;\">John Smith was admitted to the hospital with a serious abdominal infection. The nurse notices that this client is allergic to penicillin as he prepares to administer the first dose of imipenem medication. What is the nurse\u2019s next best action?<\/span>\r\n\r\nNote: Answers to the activities can be found in the \"<a href=\"https:\/\/opentextbc.ca\/nursingpharmacology\/chapter\/chapter-3\/\">Answer Key<\/a>\" sections at the end of the book.\r\n\r\n<\/div>\r\n<\/div>","rendered":"<p>Carbapenems are a beta-lactam \u201ccousin\u201d to penicillins and cephalosporins.<\/p>\n<p><strong>Indications for Use:<\/strong> Carbapenems are useful for treating life-threatening, multidrug-resistant infections due to their broad spectrum of activity.<a class=\"footnote\" title=\"Papp-Wallace, K. M., Endimiani, A., Taracila, M. A., &amp; Bonomo, R. A. (2011). Carbapenems: past, present, and future. Antimicrobial agents and chemotherapy, 55(11), 4943\u20134960. https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3195018\/\" id=\"return-footnote-98-1\" href=\"#footnote-98-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a> These antibiotics are effective in treating gram-positive and gram-negative infections. Because of their broad spectrum of activity, these medications can be especially useful for treating complex hospital-acquired infections or for clients who are immunocompromised.<\/p>\n<p><strong>Mechanism of Action:<\/strong> Carbapenems are typically bactericidal and work by inhibiting the synthesis of the bacterial cell wall.<\/p>\n<p><strong>Nursing Considerations Across the Lifespan:\u00a0<\/strong> Some carbapenems (eg. meropenem) are considered safe for use in pediatrics. Dose adjustments are required based on renal dysfunction in older adults. Information related to carbapenems in pregnancy is limited.<\/p>\n<p><strong>Specific Administration Considerations:<\/strong> Carbapenems are similar to cephalosporins.\u00a0 Cross sensitivity may occur in clients allergic to pencillin or cephalosporins.<\/p>\n<p><strong>Client Teaching &amp; Education:\u00a0 <\/strong>Clients should monitor for signs of superinfection and report any occurrence to the provider.\u00a0 If a client experiences fever and bloody diarrhoea, they should contact the provider immediately.\u00a0 The client should also be advised that side effects can occur even weeks after the medication is discontinued.<a class=\"footnote\" title=\"uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral\" id=\"return-footnote-98-2\" href=\"#footnote-98-2\" aria-label=\"Footnote 2\"><sup class=\"footnote\">[2]<\/sup><\/a><\/p>\n<h1>Carbapenems Medication Card<\/h1>\n<p>Now let&#8217;s take a closer look at the medication card for Carbapenems.<a class=\"footnote\" title=\"Daily Med, https:\/\/dailymed.nlm.nih.gov\/dailymed\/index.cfm, used for hyperlinked medications in this module. Retrieved June 27, 2019.\" id=\"return-footnote-98-3\" href=\"#footnote-98-3\" aria-label=\"Footnote 3\"><sup class=\"footnote\">[3]<\/sup><\/a><a class=\"footnote\" title=\"UpToDate (2021). Meropenem. https:\/\/www.uptodate.com\/contents\/search\" id=\"return-footnote-98-4\" href=\"#footnote-98-4\" aria-label=\"Footnote 4\"><sup class=\"footnote\">[4]<\/sup><\/a> Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication.<\/p>\n<div class=\"textbox textbox--learning-objectives\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\">Medication Card 3.8.1: Carbapenems (Antimicrobials)<\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<p><strong>Class: <\/strong>Carbapenems<\/p>\n<p><strong>Prototypes: <\/strong><a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=f41d8abd-7792-4918-1b93-bd83ea01955e\" rel=\"noopener\">imipenem<\/a> and <a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=186e8e7c-0a2a-4e48-b5f7-a036f351ca5f\">meropenem<\/a><\/p>\n<p><strong>Mechanism: <\/strong>Bactericidal. Broad-spectrum for both gram-positive and gram-negative infections.<\/p>\n<h3>Therapeutic Effects<\/h3>\n<ul>\n<li>Monitor for systemic signs of infection:\n<ul>\n<li>WBC<\/li>\n<li>Temperature<\/li>\n<li>Culture results<\/li>\n<\/ul>\n<\/li>\n<li>Monitor site of infection for improvement<\/li>\n<\/ul>\n<h3>Administration<\/h3>\n<ul>\n<li>Onset: immediate (IV)<\/li>\n<li>Peak: 5 min<\/li>\n<li>Duration: 10-12 mins<\/li>\n<li>\u00bd life: 1 hr<\/li>\n<li>Geri: use cautiously<\/li>\n<\/ul>\n<h3>Indications<\/h3>\n<ul>\n<li>Complex body cavity, connective tissue infections in hospitalized pts.<\/li>\n<li>Bone, joint, skin, soft tissues infections<\/li>\n<li>Bacterial endocarditis<\/li>\n<li>Intra-abdominal infection<\/li>\n<li>Pneumonia<\/li>\n<li>Gynecological infection, UTI<\/li>\n<li>Septicemia<\/li>\n<li>Meropenem: only drug for bacterial meningitis<\/li>\n<\/ul>\n<h3>Contraindications<\/h3>\n<ul>\n<li><strong>Caution Drugs<\/strong>: Valporic Acid, Cyclosporine, ganciclovir, probenecid (not with Meropenem): worsen seizures, confusion<\/li>\n<li>pt\u2019s who have had <strong>anaphylactic<\/strong> rxns to beta-lactams<\/li>\n<li>Impaired renal function<\/li>\n<li>Pregnancy (only use if benefits outweigh risk to fetus)<\/li>\n<li>Hx of renal disease<\/li>\n<li>Seizure disorder<\/li>\n<\/ul>\n<h3>Side Effects<\/h3>\n<ul>\n<li>Similar to cephalosporins<\/li>\n<li>CNS: confusion, seizures, Neurotoxicity at high concentrations<\/li>\n<li>Resp: Apnea<\/li>\n<li>GI: GI upset (including dysbiosis, C-diff), <strong>N\/V, diarrhea, dehydration, <\/strong>electrolyte imbalance<\/li>\n<li>Derm: Rash (Drug reaction w\/ Eosinophilia and Systemic Systems<\/li>\n<li>Superinfection<\/li>\n<\/ul>\n<h3>Nursing Considerations<\/h3>\n<ul>\n<li>Monitor skin<\/li>\n<li>Monitor bowels<\/li>\n<li>Monitor labs<\/li>\n<li>Monitor CNS<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<div class=\"textbox textbox--key-takeaways\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\">Clinical Reasoning and Decision-Making Activity 3.7a<\/p>\n<\/header>\n<div class=\"textbox__content\">\n<p><span style=\"text-align: initial; font-size: 1em;\"><strong>Using the above information, consider the following clinical scenario question:<\/strong><\/span><\/p>\n<p><span style=\"text-align: initial; font-size: 1em;\">John Smith was admitted to the hospital with a serious abdominal infection. The nurse notices that this client is allergic to penicillin as he prepares to administer the first dose of imipenem medication. What is the nurse\u2019s next best action?<\/span><\/p>\n<p>Note: Answers to the activities can be found in the &#8220;<a href=\"https:\/\/opentextbc.ca\/nursingpharmacology\/chapter\/chapter-3\/\">Answer Key<\/a>&#8221; sections at the end of the book.<\/p>\n<\/div>\n<\/div>\n<hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-98-1\">Papp-Wallace, K. M., Endimiani, A., Taracila, M. A., &amp; Bonomo, R. A. (2011). Carbapenems: past, present, and future. <em>Antimicrobial agents and chemotherapy, 55<\/em>(11), 4943\u20134960. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3195018\/\" rel=\"noopener noreferrer\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3195018\/<\/a> <a href=\"#return-footnote-98-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><li id=\"footnote-98-2\">uCentral from Unbound Medicine. <a href=\"https:\/\/www.unboundmedicine.com\/ucentral\" rel=\"noopener noreferrer\">https:\/\/www.unboundmedicine.com\/ucentral<\/a> <a href=\"#return-footnote-98-2\" class=\"return-footnote\" aria-label=\"Return to footnote 2\">&crarr;<\/a><\/li><li id=\"footnote-98-3\">Daily Med, <a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/index.cfm\" rel=\"noopener noreferrer\">https:\/\/dailymed.nlm.nih.gov\/dailymed\/index.cfm<\/a>, used for hyperlinked medications in this module. Retrieved June 27, 2019. <a href=\"#return-footnote-98-3\" class=\"return-footnote\" aria-label=\"Return to footnote 3\">&crarr;<\/a><\/li><li id=\"footnote-98-4\">UpToDate (2021). <em>Meropenem<\/em>. <a href=\"https:\/\/www.uptodate.com\/contents\/search\">https:\/\/www.uptodate.com\/contents\/search<\/a> <a href=\"#return-footnote-98-4\" class=\"return-footnote\" aria-label=\"Return to footnote 4\">&crarr;<\/a><\/li><\/ol><\/div>","protected":false},"author":90,"menu_order":8,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[50],"contributor":[],"license":[],"class_list":["post-98","chapter","type-chapter","status-publish","hentry","chapter-type-numberless"],"part":70,"_links":{"self":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/98","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/wp\/v2\/users\/90"}],"version-history":[{"count":6,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/98\/revisions"}],"predecessor-version":[{"id":1414,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/98\/revisions\/1414"}],"part":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/parts\/70"}],"metadata":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/98\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/wp\/v2\/media?parent=98"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapter-type?post=98"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/wp\/v2\/contributor?post=98"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/wp\/v2\/license?post=98"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}